BA-Application-for-Center-Staff-7-2021-edited

Work in a Vermont regulated preschool, child care center, or home program for at least 30 hours per week.. Early Childhood® VERMONT Bachelor Degree Scholarship offered through VTAEYC req

*Please complete all questions, attach pay stub, and ensure signatures are acquired in order for application to

be considered complete*

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T.E.A.C.H Early Childhood® VERMONT Bachelor's Degree Scholarship Eligibility Requirements

1 Work in a Vermont regulated preschool, child care center, or home program for at least

30 hours per week.

2 Has worked with children birth to age 5 in their current program for at least 3 months.

3 Work in a program that has no recurring licensing violations per Child Development

Division Child Care Licensing Division.

4 Is working toward an early childhood degree at a Vermont college (or would like to be)

5 As a professional, be willing to make a commitment to continue working at your present place of employment for one year after your contract ends.

6 Has the support of their employer and provides proof of participation or willingness to participate in a quality initiative such as STARS, Head Start, or NAEYC/NAFCC

accreditation.

be considered complete*

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Date: _

Personal Information

Name: Mailing Address: City/State/Zip: County: Email: Phone Number(s): Home: _ Work: Cell: _ Social Security Number: - - Date of Birth: _ Gender:

(mm/dd/yyyy)

Ethnicity

Do you consider yourself….?

American Indian or Alaska Native

Native Hawaiian or Pacific Islander (includes

Samoan, Chamorro or other Pacific Islander)

Black or African American

White

Asian (includes Asian Indian, Japanese, Chinese, Korean, Vietnamese, Filipino or other Asian) Other (two or more races)

Other

How did you hear about the T.E.A.C.H Early Childhood® Project?

Presentation

Mailing

Northern Lights @ CCV

College

My Center Director T.E.A.C.H Recipient Workshop

Website

Child Development Division Social Media (Insta or FB) Mentor: Other:

Do you consider yourself Latinx?

Yes (includes Mexican, Mexican American, Chicano,

Employment Status

What is your

current job title? Teacher

Trainee Teacher Associate Teacher Assistant

Director Owner Other: _ Classroom Aide Director When did you begin employment at your current facility?

How many hours per week do you work?

How many months per year do you work?

How many children are in your classroom?

How long have you worked in the field

of early childhood education? Less than 2 years

6-10 years

2-5 years 10+ years

What age groups do you teach (please

Preschool (37 months to Pre K)

Toddler (13-36 months) School Age

Please check the boxes that best describe your educational history:

No high school diploma

High school diploma/GED

Year

Technical Education

Center/Human Services

Program: Year _

CDA Credential: Year

Apprenticeship Certificate Year _

College Child Care Certificate: Year

Associate Degree: Year

Major: _

Bachelor Degree: Year _ Major: Master’s Degree: Year Major: Doctorate: Year _ Concentration:

Please check one that best describes your educational goal:

Earn a Bachelor Degree

Earn a Master’s Degree

Earn an Early Childhood or Early Childhood Special

Education License

Saint Michael's College Champlain College Northern Vermont University

Springfield College Castleton University When would you like your scholarship to begin?

Have you earned college credits in the past two years?

YES, how many total credits? How many ECE credits? NO

At what college or university have you earned college credit? _ What school would you like to attend to complete your Bachelor's Degree?

FALL SPRING SUMMER _ (YR)

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Which of the following credentials and specializations do you currently hold?

Please submit a copy of any certificates or licenses you hold.

 CDA: Infant/Toddler

 CDA: Preschool

 CDA: Family Child Care

 CDA: Home Visitor

 Specialization: Bi-Lingual

(language: _)

 Apprenticeship Certificate

 Child Care Certificate

 Teaching License (State/Level _)

 Northern Lights Career Ladder Level Certificate: Level Reached

Are you familiar with the Early Childhood Career Ladder? YES NO

Do you actively use your Bright Futures Information System (BFIS) Quality Credential Account?

YES, Account # _ NO NOT SURE

If you are unsure of your account number, please find it at www.brightfutures.dcf.state.vt.us/

Do you have a NAEYC/VTAEYC Membership?

**Please note: You are required to become a VTAEYC member upon signing a TEACH contract.** YES, Account # _ NO

Statement of Income: (Please attach a copy of your most recent pay stub(s))

Job #1 Employer Hours/Week _ Earnings per Job #2 Employer Hours/Week _ Earnings per

You must apply for Federal financial aid (FAFSA) Have you applied? YES NO

If no, please contact VSAC immediately for assistance 1-800-642-3177 or info@vsac.org

Other Source of financial aid #1 _

Date of application

Application Status: AWARDED DENIED SUBMITTED/PENDING

Other Source of financial aid #2 _

Date of application

Application Status: AWARDED DENIED SUBMITTED/PENDING

Please attach your financial award or denial letter(s) here or submit them separately if status is currently pending

HAVE YOU EVER DEFAULTED ON STUDENT LOANS IN THE PAST? Yes No

YOUR TOTAL ANNUAL INCOME $

YOUR TOTAL ANNUAL FAMILY INCOME (all household adult earnings) $ _

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Family Structure

How many people total live in your household? Number of Relationship

Parents Siblings Spouse/Significant Other Children

Other

Have any of your parents or any of your brothers and sisters attended college? YES NO

Do any of your parents or any of your brothers and sisters have a college degree? YES NO What languages can you speak fluently? _ What is your preferred language for learning? _

STATEMENT & SIGNATURE OF APPLICANT

I attest to the fact that the information I have provided in this application is true and accurate Based on this

information I am applying to VTAEYC for a scholarship to help pay the cost of educational expenses

Signature of Applicant Printed Name of Applicant Date

Application Checklist: to be completed by the applicant:

Copy of any early childhood certificates or licenses

Copy of STARS certificate (if applicable)

Copy of NAEYC/NAFCC accreditation (if applicable)

Income verification (current paycheck stub, Schedule C, etc.)

Completed participation agreement statement (pg 4 for participants, pg 5-6 for sponsoring programs) Financial aid (FAFSA) proof of application

Copy of prior college transcripts (unofficial copies accepted)

If you have any questions about completing the application contact us at (802) 387-0870 or email at

teachearlychildhoodvermont@vtaeyc.org

Please scan and email packet to teachearlychildhoodvermont@vtaeyc.org

Updated 7-2021

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Sponsor Program Participation Agreement

This agreement must be completed by the program director for teachers, or the owner/board chairperson for directors The T.E.A.C.H Early Childhood® VERMONT Bachelor Degree Scholarship offered through VTAEYC requires the

participation of each scholarship recipient’s employer In the event that (Applicant Name)

is awarded a scholarship, I understand that (Program Name)

agrees to participate in the following way:

Director/Owner: Pay 20% of the cost of tuition for 9-15 semester hours per contract for the scholarship

employee

Employee Director (bonus option): Pay 10% of the cost of the tuition for 9-15 semester hours per contract for

the scholarship employee Upon successful completion of the contract and 9-15 credit hours, award a $500 bonus Employee Director (raise option): Pay 10% of the cost of the tuition for 9-15 semester hours per contract for

the scholarship employee Upon successful completion of the contract and 9-15 credit hours, issue at least a 1.5% raise Teacher (bonus option): Pay 10% of the cost of tuition for 9-15 semester hours per contract for the scholarship

employee Provide release time each week for my scholarship employee Upon successful completion of the contract and 9-15 credit hours, award a $300 bonus

Teacher (raise option): Pay 10% of the cost of tuition for 9-15 semester hours per contract for the scholarship

employee Provide release time each week for my scholarship employee Upon successful completion of the contract and 9-15 credit hours, issue at least a 1.5% raise

I understand the roles and responsibilities of the sponsor (employer) and scholarship employee and I agree to do

my best to support my scholarship employee in this program I will contact the T.E.A.C.H Vermont office to address any concerns I may have regarding the T.E.A.C.H Bachelor's Degree Scholarship Program

Authorized Signature: Date: _ Name (Printed): _ Title:

Program Information:

Name of Program (as it appears in BFIS): _ Program Mailing Address: County: Federal ID #: Program Physical Address (if different): _ County: Program Auspice:

(PLEASE CONTINUE ON OTHER SIDE)

Non-Profit Profit Head Start Public School Religiously Sponsored

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Name of Director/Owner: _ Phone: _Email: Program License Number: _ Number of Children Licensed for: _ STARS Rating: _ NAEYC Accreditation:

Days and Hours of Operation: Number of Children Enrolled: Full Year School Year

Please check all forms of funding your facility receives:

Head Start Early Head Start State Pre-K Title I

IDEA Child Care Subsidy (CCFAP) Other: Does your program have an ACT 166 public Pre-K partnership? YES NO

The Program’s regulatory history will be reviewed through BFIS Programs with serious violations in the last 12 months, as defined through the State of Vermont Child Care Licensing Regulations, must contact T.E.A.C.H Vermont

to determine eligibility A site visit and discussion with your licensor may occur prior to accepting recipients

Application Checklist: to be completed by the applicant:

Copy of any early childhood certificates or licenses

Copy of STARS certificate (if applicable)

Copy of NAEYC/NAFCC accreditation (if applicable)

Income verification (current paycheck stub)

Completed participation agreement statement (pg 4 for participants, pg 5-6 for sponsoring programs) Financial aid (FAFSA) proof of application (or statement of intent to apply with due date)

Copy of prior college transcripts (if applicable and unofficial copies accepted)

If you have any questions about completing the application contact us at (802) 387-0870 or email at

teachearlychildhoodvermont@vtaeyc.org.

Please scan and email packet to teachearlychildhoodvermont@vtaeyc.org

YES NO